Seo Hye Won, Lee Sua, Lee Hwa Young, Park Sun Cheol, Chung Byung Ha, Yang Chul Woo, Ban Tae Hyun
Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju-do 63241, South Korea.
World J Clin Cases. 2020 Feb 6;8(3):540-545. doi: 10.12998/wjcc.v8.i3.540.
Due to a shortage of donor kidneys, many centers have utilized graft kidneys from brain-dead donors with expanded criteria. Kidney transplantation (KT) from donors on extracorporeal membrane oxygenation (ECMO) has been identified as a successful way of expanding donor pools. However, there are currently no guidelines or recommendations that guarantee successful KT from donors undergoing ECMO treatment. Therefore, acceptance of appropriate allografts from those donors is solely based on clinician decision.
We report a case of successful KT from a brain-dead donor supported by ECMO for the longest duration to date. A 69-year-old male received a KT from a 63-year-old brain-dead donor who had been on therapeutic ECMO treatment for the previous three weeks. The recipient experienced slow recovery of graft function after surgery but was discharged home on post-operative day 17 free from hemodialysis. Allograft function gradually improved thereafter and was comparatively acceptable up to the 12 mo follow-up, with serum creatinine level of 1.67 mg/dL.
This case suggests that donation even after long-term ECMO treatment could provide successful KT to suitable candidates.
由于供体肾脏短缺，许多中心已采用标准放宽的脑死亡供体的移植肾。来自接受体外膜肺氧合（ECMO）治疗的供体的肾移植（KT）已被视为扩大供体库的一种成功方式。然而，目前尚无确保接受ECMO治疗的供体成功进行肾移植的指南或建议。因此，接受来自这些供体的合适同种异体移植物完全取决于临床医生的决定。
我们报告了一例迄今为止由ECMO支持时间最长的脑死亡供体成功进行肾移植的病例。一名69岁男性接受了一名63岁脑死亡供体的肾移植，该供体此前已接受了为期三周的治疗性ECMO治疗。受者术后移植肾功能恢复缓慢，但在术后第17天出院，无需进行血液透析。此后，同种异体移植物功能逐渐改善，直至12个月随访时相对良好，血清肌酐水平为1.67mg/dL。
该病例表明，即使经过长期ECMO治疗，捐赠仍可为合适的受者提供成功的肾移植。
